History and Physical Examination

  • Gary I. PolykoffEmail author
  • Jaleesa Jackson


A careful history and physical examination are of primary importance in the evaluation of a patient with spine pain and related symptoms. It can be the difference between sending a patient home with a conservative treatment plan and admitting the patient for an immediate evaluation and possible surgery. The history and physical examination can determine if an expensive evaluation is necessary immediately or whether conservative treatment is appropriate first.

Spine pain is a common problem throughout the world and is a significant cause of pain and loss of function. Lifetime prevalence estimates are as high as 84% for back pain and 67% for neck pain. Low back pain (LBP) is a leading cause of disability, with lost wages estimated at over $200 billion in 2002–2004. At any one time, about 5% of the US population has sufficient neck pain to cause disability.

Although the likelihood of defining a precise cause of spine pain is low, if the etiology and structural source can be determined, they may be valuable in directing treatment. Patient history serves to identify red flags and yellow flags, whereas the physical examination, guided by the history, serves primarily to confirm those suspicions. Careful history and physical examination are essential in the diagnostic evaluation of patients with spine pain. During the history and physical examination, the clinician must be cognizant of signs or symptoms that may indicate a more serious disorder by attending to red flags and yellow flags. The differential diagnosis of neck and back pain is extensive, and although most of the pain is benign and self-limiting, the real challenge to the clinician is to distinguish serious spinal pathology or nerve root pain from nonspecific spine pain. The etiology is usually multifactorial with involvement of muscles, ligaments, discs, nerve roots, and zygapophysial (facet) joints.


History Physical examination Differential diagnosis Neck pain Low back pain Spine Radiculopathy Myofascial Facet joint Compression fracture 


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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical SchoolBostonUSA

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